Evaluation of unstructured medical school examinations: prospective observational study

To evaluate the final examination in Ambulatory General Internal Medicine of the Medical School of the University of Basel, Switzerland regarding students' performance rated by examiners and patients, examiners' and students' self-assessment and examiners' performance concerning fairness and difficulty of the examination rated by students and patients.

Prospective observational study of 144 Medical students judged by 29 pairs of examiners. Students examined 66 real untrained outpatients. Assessment by questionnaire during an unstructured final Medical School examination. Marks could be given between 1 (= very poor) to 6 (= very good). Fairness and difficulty of the examination was measured by visual analogue scale (1 to 10).

Patients judged students' performance better than examiners (5.45 +/- 0.46 vs. 5.22 +/- 0.65, p = 0.005). Examiners assessed students performance better than the students themselves (5.22 +/- 0.61 vs. 4.91 +/- 0.54, p = 0.001). Patients considered examiners as having examined fairly in 84.6%, and students rated examiners as having examined fairly on visual analogue scale (1.29 +/- 1.75). Students and examiners judged the exam to be similarly difficult (5.97 +/- 1.76 vs. 5.92 +/- 1.14, p = 0.77, r = 0.72).

An unstructured Medical examination - the long case - provides consistent results which are accepted as fair by the students, patients and examiners. Patients and examiners judge students' performance more benignly than students themselves. Examiners and examinees consider the long case as serving a meaningful purpose regarding assessment of clinical competence and doctor/patient relationship.